Hepatic Lipofuscin Deposition in Living Liver Donor Candidate

Living donor liver transplantation (LDLT) is an important therapeutic option, and ensuring donor safety is paramount. We report a case of a woman in her early 50s evaluated as a living liver donor candidate for her husband. Recurrent mild elevations of alanine aminotransferase (ALT) levels prompted further investigation, and a percutaneous ultrasound-guided liver biopsy revealed unexpected and marked lipofuscin deposition within hepatocytes, without evidence of steatosis, inflammation, fibrosis, or cholestasis. Lipofuscin, an age-related pigment, is generally considered benign, with an unclear association with hepatic dysfunction. In this case, the donor was excluded due to recurrent unexplained liver dysfunction rather than the presence of lipofuscin deposition itself. Histopathological evaluation plays a critical role in living donor selection, particularly when liver dysfunction is suspected. Furthermore, unexpected histopathological findings, such as lipofuscin deposition, serve to reaffirm the necessity of thorough interpretation and comprehensive discussion within the transplant team, with careful consideration of donor safety and graft functionality.